Airline Fees At The Doctor’s Office

It finally happened. Last night, in a close vote along party lines, the Senate failed to block a scheduled 21% cut in Medicare pay to doctors. While there’s nothing less appealing than a doctor whining about their pay, keep in mind that this Medicare pay cut now means that your primary care doctor will be paid less than your SuperCuts hairdresser. Minus the tip.

I’m serious. The pay range among types of doctors is huge – and is often even a shocker for doctors themselves. While surgical specialists can easily be making a million a year, I found, for example, that I’d get paid, as a full-time private practice internist at a premiere medical group, in a job with two weeks of vacation, lots of after-hours call, and tons of medical liability…(wait for it)…50% less than our local elementary school principal (who gets summers off, a three-week winter break, and a day that ends at 2:30pm). And she’s rarely sued. Cut THAT pay by 21% and you’re talking serious trouble getting an appointment with anyone. Ever.

Nickled and died?

So how are the few remaining primary care doctors coping? Some are advocating airline-type fees for all kinds of activities (including for writing doctor’s notes, having forms filled out, and returning emails). Some docs apparently haven’t waited for the long-threatened Medicare pay cut. Here’s a letter from an insured patient – a Doc Gurley reader who’s also an advanced-degree healthcare professional – which just may illustrate the future of your healthcare [note: letter has been edited for length and to ensure confidentiality]:

Good morning, Doc. I just wanted to share an extremely disappointing experience I had yesterday.

I’ve begun looking for a new internist to see. So, with the list of doctors on my health insurance plan narrowed down to female internists within a 20 mile radius of home, I called around to find one who is accepting new clients.

To make a long story short, my first appointment was an hour long, but I never received a physical exam. The doctor’s P.A. saw me. She took my history, explained the “concierge service” plan to me and listened to my heart and lungs, period. Now this special “concierge service” costs $1,800 a year, this year. It offers the opportunity to see the doctor within 2 days of calling for an appointment. Without paying the extra out-of-pocket concierge fee, patients see the P.A. only. The P.A. is only around 3 days a week. When the P.A. heard another exam room’s door open she interrupted her spiel to duck out and bring the doctor in to shake my hand and see if I had any questions to ask about the “concierge service.” I took the opportunity to explain that my doctoring needs are pretty simple. This doctor explained that if I signed up for the “concierge service,” I could see her within a day or two. I had the distinct impression that everything about her practice was about raking in the $$$$, certainly not much about personal contact, and who knows what kind of medical care, really. Oh, for the $1,800 one also gets the good doctor’s cell phone number, so one can leave messages with questions on her answering service, and she’ll return a call up to 8:00 in the evening.

I came away furious, and I’ll be damned if I pay into her racket! It felt more like extortion to me – pay me big bucks out of pocket, and I’ll let you see an actual doctor. It took me a month to get this initial appointment at this practice, and I’m pretty sure I don’t want to try to work with this doctor. I guess I’m back to square one, with the list of preferred practitioners on the insurance company’s panel, and a new question to add to my phone interview: “Do you have a ‘concierge service?'”

Extorted in Extremis

So is there anything wrong with this arrangement? There’s no law against it. Heck, since reimbursement for P.A. visits is significantly lower, insurance companies are likely to be very happy with this approach – at least in the short run. And with many for-profit insurance companies, the short run is what it’s all about. And if all doctors in an area take this same approach, your insurance becomes just a way to see a P.A. – never a doc. Should you have to pay extra to be cared for, personally, by your insurance-assigned doctor? P.A.s have worked with doctors for many many years – but even when the arrangement works well, there’s always been a “common sense” understanding that patients who are complicated should be seen by the doctor. At least a few times. What if the only patients who can personally see the doc, no matter how complex or serious the problem, are the ones who pay the extra fee? Concierge arrangements have also been around for a while. But the “understanding” was that concierge service was an optional upgrade you could choose – not a mandatory fee you must pay to have access to your assigned physician.

Hmm, how long do you think it will be until you get weighed at the clinic door to see if you’re over your limit for your medical baggage?

What do you think? Should doctors implement fees for insured patients? Should you pay extra for access? Sound off in the comments section. Doc Gurley is the only Harvard Medical School graduate, ever, to be awarded the coveted Shoney’s Ten Step Pin for documented excellence in waitressing, and is a practicing board-certified internist. You can get more health posts at, or jump on the Twitter bandwagon and follow Doc Gurley. Also check out Doc Gurley’s joyhabit and iwellth twitter feeds – so you can get topic-specific fun, effective, affordable tips on how to nurture your joy and grow your personal wellth.

Enhanced by Zemanta

Comments are closed.